What does preexposure prophylaxis mean for treatment; what does treatment mean for preexposure prophylaxis?

Abstract

This article discusses the intersection of the two interventions, some programmatic misconceptions and complexities, and argues that PrEP is a nuanced and useful adjunct to HIV programmes. PrEP can be rolled out in a way that complements treatment, possibly even within primary health clinics, and may be required for the many people in whom TaP currently fails. PrEP will need constant adaptation so as to maintain programmatic and cost-effectiveness, as the epidemiology of HIV changes with TaP rollout and expansion as CD4 restrictions are lifted. Finally, the article also argues that so-called ethical concerns around competing resources are relatively easily resolved.

Pre-exposure Prophylaxis: The Delivery Challenge

“…The field needs to consider whether this is truly necessary, as it introduces yet another blood draw and visit to the clinic, as well as interfering with self-testing initiatives. The same holds for hepatitis B, where withdrawal of tenofovir in those with chronic replicative hepatitis B, has been associated with isolated anecdotes of “flares” ( 12 ).…”

“…In addition, messaging is that ART should never be interrupted, once initiated. This conflation is presumably because both ART and PrEP involve antiretrovirals (often the same antiretrovirals) ( 12 ).…”

“…The routine blood monitoring that is required from current PrEP programmes is a major operational complexity ( 12 ). At the least, regular HIV testing is required.…”

“…A screening renal test (the creatinine clearance) is cheap and easily integrated within the HIV testing algorithm. No cases of renal failure have yet been seen after a normal screening test, using tenofovir-containing PrEP, but most guidelines recommend continuing monitoring ( 12 , 17 ). The field needs to consider whether this is truly necessary, as it introduces yet another blood draw and visit to the clinic, as well as interfering with self-testing initiatives.…”

Integration of pre-exposure prophylaxis services into public HIV care clinics in Kenya: a pragmatic stepped-wedge randomised trial

“…In many African countries, public HIV care and treatment programmes have been very successful at scaling up antiretroviral therapy (ART) over the past 15 years and are an attractive choice for integration of PrEP delivery. 7 , 8 HIV care clinics in Africa routinely provide HIV prevention services including HIV testing services and condom distribution to uninfected partners of persons living with HIV, thus providing a ready PrEP-eligible population. 7 , 9 In addition, health-care providers in these clinics are conversant with prescribing and counselling on antiretroviral medication use, and the clinics have an established commodity management system for ART and HIV test kits.…”